Healthcare Provider Details

I. General information

NPI: 1508115635
Provider Name (Legal Business Name): KIMBERLY KEER HEYMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S SEPULVEDA BLVD SUITE 305
LOS ANGELES CA
90049-3521
US

IV. Provider business mailing address

13351 RIVERSIDE DR # 157
SHERMAN OAKS CA
91423-2542
US

V. Phone/Fax

Practice location:
  • Phone: 310-560-6691
  • Fax:
Mailing address:
  • Phone: 310-560-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS19460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: